Respect for conscience must be a social value

In mature Western democracies we have competing societal values, with
abortion at the eye of the storm.

In Canada . . . pro-choice
advocates are not content with having the freedom to
act according to their values; they want to make
others, for whom it would be a breach of their
values, act likewise. . . these people claim freedom
of values belief for themselves, but refuse to
respect others' freedom. That's why they will not
tolerate a respect-for-freedom-of-conscience
exception. No matter what our values or views, we
should all be concerned by such totalitarianism and
fundamentalism.

Michael Cook reports that
new legislation in Victoria, Australia,
"decriminalises abortion and forces doctors with a
conscientious objection to refer a woman to a doctor
who will do an abortion. In the event of an
'emergency' abortion â€¦ regardless of their moral
qualms, doctors must do [an abortion] themselves.
Victorian nurses will be in an even worse
predicament. They must participate in an abortion if
ordered by their boss." The same scenario, in a
somewhat softer version, is being played out in the
United States and Canada. Here, codes of
professional conduct or regulations, rather than
legislation, are being proposed to limit freedom of
conscience rights with respect to abortion.

An effort is also underway by pro-abortion
advocates, led by International Planned Parenthood,
to have the United Nations declare access to
abortion a universal human right.

Healthcare professionals who, despite such
coercion, follow their conscience risk a variety of
legal threats. Their conduct can be found to
constitute discrimination under human rights codes,
or professional misconduct when it would result in
disciplinary proceedings and penalties ranging from
reprimands to fines and loss of a license to
practice medicine or to practice as a nurse.

Needless to say, this state of affairs has caused
deep concern for many healthcare professionals. What
has led to this situation and what might be its
wider consequences? To respond to that question and
deal with this situation, I believe we need to
understand two new realities, a political reality
and a medical reality.

The political reality

I suggest there is a
political problem caused by the disproportionate
influence on politicians of what are being called
'hard minorities' such as the pro-choice lobby, as
compared with 'soft majorities'.

I suggest there is a political problem caused by
the disproportionate influence on politicians of
what are being called "hard minorities" such as the
pro-choice lobby, as compared with "soft
majorities". Canadian Prime Minister Stephen
Harper's stance on abortion in the context of this
week's Federal election reflects this reality. I
thought about what I'd say to him about his stance,
were I to write him an open letter. Here's what I
drafted (but did not publish):

Dear Prime Minister,

I write regarding some media
reports about your views on abortion and the law,
which I believe raise serious concerns for many
Canadians.

For instance, it's reported
you don't believe abortion is an important issue,
but you do believe "arts and fitness funding for
children" is an "important challenge". And you
"would 'whip' [your] front bench so that none of
[your] cabinet ministers would support any private
member's bills that could re-open the [abortion]
debate". (Globe and Mail, 29 Sep).

Here are some questions I
would respectfully ask you: Your statements can
reasonably be interpreted -- and no doubt will be --
as affirming that the societal values norm you
accept (and will impose on your Cabinet) is that
abortion raises no moral or ethical concerns,
including for society. That's the pro-choice
position -- a simple and straightforward stance
based entirely on the rights of individual women.
Yet, in the past, you've rightly described abortion
as a "complex" issue. I thought that meant you
accepted that abortion does raise moral and ethical
concerns, at least for society. Addressing those
concerns, including those relating to shared
societal values, requires some law on abortion, as
around 70 percent of Canadians agree. Are you now
saying there should never be such law?

What about respect for
"freedom of conscience" of your cabinet ministers?
Your position reflects that taken recently by the
Ontario Human Rights Commission in advising the
College of Physicians and Surgeons of Ontario. It
warned that physicians who refused to facilitate
procedures contrary to their moral or religious
beliefs, which patients requested, could be in
breach of the patients' human rights. It recommended
physicians "leave their personal beliefs outside the
surgery" -- park their ethics and values with their
cars. Such a stance is "power speaking to truth",
even if it's only the truth of some cabinet
ministers' consciences.

Students for Choice have been
lobbying Canadian medical schools to make abortion a
"required procedure". That would mean students must
competently perform an abortion to graduate as MDs.
Might your refusal to respect cabinet ministers'
freedom of conscience be a similarly restrictive
condition that will expressly exclude some MPs from
"graduating" to cabinet?

I believe abortion in the late
20th and early 21st centuries will come to be seen
as a great human tragedy, just as we now see slavery
or racism. We now regard politicians who supported
those practices as being involved in appalling human
rights abuses and failure to respect other human
beings. Might the same be true of contemporary
politicians whose absolute silence on abortion meant
there were no protections for unborn children, even
those who would live if delivered instead of being
killed?

I'm an ethicist, not an
activist, and I'm far from being a classical
anti-abortion activist. While I believe that
abortion is always a serious ethical issue, I do not
support legally prohibiting early abortion, although
I fervently hope it would be a rare occurrence. My
position has put me at odds with both some pro-life
and all pro-choice groups. That said, I'm more and
more convinced that abortion is the single most
important issue we are dealing with in terms of the
future shared values on which we will base our
society and that history's verdict will affirm that.

Among the reasons are, first,
that abortion is not just an issue for individual
women, much as pro-choice advocates adamantly push
that view. Unavoidably, our collective stance on
abortion is an important element in establishing
society's value of respect for life. The current
Canadian situation -- a unique one among comparable
countries of having no law to protect even viable
fetuses -- necessarily damages that value,
especially when abortion is commonplace and regarded
with equanimity. It also seriously damages our
"values environment" as a whole. We need to be as
sensitive to caring for that as we now recognize we
must be in caring for our physical environment.

Second, abortion is just the
tip of an iceberg of several competing worldviews
that encompass many different and often conflicting
values. Consequently, what we decide about abortion
will have many flow-on effects to other values well
beyond those relevant to abortion. In particular, a
central issue in deciding about many important
values on which we currently disagree, not the least
of which is euthanasia, is where to strike the
proper balance between intense individualism at one
pole and intense communitarianism at the other. As
described, your current position on abortion affirms
intense individualism.

So, let's apply this value
choice to some other questions. Even limiting
ourselves to just the area of adults' "rights" with
respect to their children, will we likewise accept
that there should be no restrictions on designing
one's child? And what about transhumanism: are there
limits that need to be respected to keep the essence
of our humanness intact for future generations?

I have spoken with some
election candidates about your stance on abortion.
One, from your party, told me he is a practicing
Catholic but would go along with you because
"abortion is a political question, not an ethical or
moral one". He argued that the moral and ethical
issues are only between a woman and her doctor -- a
classic pro-choice argument -- and he added that
"one has to make compromises in politics".

(An aside: I ended up voting
for a candidate from a party I would not usually
support, who told me there were five percent of
issues on which he would never vote against his
conscience. I respected him for that -- it was the
response nearest to my own values that I was able to
obtain, so it was either vote for him or abstain
from voting. I subsequently wrote to him: 'I am
hoping that one of your conscience issues would mean
that if legislation providing some protection from
abortion for viable fetuses were to be presented in
Parliament, you would not vote against it. As I
explained when we met, I believe this matter goes
beyond the individual woman and unborn child
involved in any given case and is a central matter
in maintaining our collective societal value of
respect for life.' He was elected. There is now a
great deal of hand-wringing in Canada about the
record low voter turnout -- 10 million eligible
voters, or 49 percent, did not vote. At least some
of them were "values voters" on a wide range of
values issues, and probably had the same problem as
I did in finding a candidate to vote for. )

Finally, that raises the issue
of why politicians, whose personal values are not
consistent with those of pro-choice advocates are so
frightened of them? One probable reason is that the
strategy of these advocates is to deliberately paint
an either/or picture -- either no restrictions on
abortion at all, or total prohibition of abortion --
that terrifies the vast majority of Canadians. Given
only that choice, they choose no restrictions,
although, as polls show, the majority would like to
see our society have a more nuanced and balanced
response to law on abortion. Politicians who take a
lead in providing such an option so that, as a
society, we can re-affirm our respect for life,
could be surprised by the support they receive.

Another reason might be that
these politicians think that people like me, who
would hope to see some protection of unborn
children, will continue to vote for them because we
have nowhere else to go. It's true we often have
nowhere else to go, which is a threat to democracy.
But it's not necessarily true we will continue to
vote for them.

With respect.Yours sincerely,Margaret Somerville

The medical reality

Would any of us really want
to be treated by a physician who had complied with a
directive to 'park your ethics and values with your
car outside the surgery'?

The push to abolish respect for physicians' and
other healthcare professionals' freedom of
conscience reflects an emerging view that physicians
are mere technicians able to provide services that
patients want and have a right to access. Thus,
physicians have a duty to provide these services and
no right to bring their moral or ethical
reservations into play; to do so is discrimination.

Think of having your car repaired: for a mechanic
to refuse to service your car just because you were
a woman would be discrimination and a human rights
offence. Some say physicians' refusal of medical
services for moral or ethical reasons is the same
thing.

Unlike the mechanic, however, a physician who
refuses to be involved in abortion is not providing
the service to one patient but not another, or
basing his refusal on any characteristic of the
patient. Rather, he is refusing the service to all
patients and doing so because of the nature of the
procedure, which he believes is morally and
ethically wrong.

And, unlike medicine, usually car repairs don't
raise moral and ethical issues. But what if you were
a bank robber preparing a getaway car and told the
mechanic that? Suddenly automotive repair would
become an ethical and moral issue. Would a refusal
still be wrong or might it even be required? And
referring the bank robber to another mechanic would
make you complicit in the wrongdoing.

The practice of medicine always and unavoidably
involves ethical and moral issues, although when we
all agree on how they should be dealt with, we might
not be consciously aware of them in day-to-day
practice. It's only when something goes wrong or
there is a conflict of values that the ethical
issues flash up on the big screen. Treating
physicians as mere technicians fails completely to
take that omnipresent ethical aspect into account.

Treating physicians as mere technicians is also
the antithesis of the traditional concept of a
physician as a professional with ethical and legal
obligations to exercise good professional judgment.
Most notable among those obligations is "first, do
no harm", which means that a physician may not
simply fulfill a patient's request, but must make an
independent judgment as to its acceptability.

At its extreme, treating physicians as mere
technicians can result in an argument that bizarre
requests should be fulfilled. For instance, some
people argue that if a person wants their healthy
right leg amputated, they have a right to that
surgery. On a more everyday level, patients'
lifestyle choices -- and the Ontario Human Rights
Commission (OHRC )warns that failure to honour them
could be discrimination -- can be a problem. Some
women who rejected physicians' advice to change
their diet if they wanted to lose weight and instead
demanded Phenphen, a weight-loss drug, died as a
result.

Treating physicians as mere technicians denies
that respect is required for physicians' freedom of
conscience and their ethical and moral values. Quite
apart from the serious wrong to physicians that
denial inherently constitutes, such an understanding
of the physician- patient relationship would do a
great disservice -- not only to the medical
profession and society in general, but also to
patients, because maintaining respect in any human
encounter, including the physician-patient
encounter, requires that respect be mutual.

In stark contrast to fostering such mutual
respect, here's the OHRC's startling view of a
physician's obligation in the physician-patient
encounter: "It is the Commission's position that
doctors, as providers of services that are not
religious in nature, must essentially 'check their
personal views at the door' in providing medical
care." The commission makes clear that physicians'
"personal views" include their deepest and most
important ethical and moral beliefs and values.
Obviously, that raises serious problems for
physicians, but again it also raises problems for
patients: Would any of us really want to be treated
by a physician who had complied with a directive to
"park your ethics and values with your car outside
the surgery"?

It's true sometimes that acting on personal views
can be discrimination: Refusing to treat a patient
simply because they were homosexual is
discrimination and wrong. But that's not the issue
here. Rather, the problem lies in classifying as
discrimination a refusal to provide or refer for a
service, such as abortion, euthanasia, or artificial
reproduction, that the physician believes -- and
many other people believe -- is morally and
ethically wrong. Such refusals should be treated
differently from refusals of morally and ethically
neutral services, such as refusals to rent an
apartment to a person or serve them in a restaurant
on the basis of a prohibited ground of
discrimination. We can all agree that is wrong.

Social reality

Although many Canadians believe that a big
difference between the United States and Canada is
that Canadians have a consensus on basic values and
Americans don't, this issue of physicians' freedom
of conscience might show us that that the former is
not true. Likewise, our recent election might show
that Canadians are wrong in believing that, unlike
Americans, they don't vote along social-ethical
values lines. In short, countries like Canada and
Australia might also be involved in the culture
wars, but in a much less high profile way than the
United States.

The reality is that in many mature Western
democracies we have competing societal values, with
abortion at the eye of the storm as the situation in
Victoria, Australia, of forcing physicians who have
conscientious objections to do or refer for an
abortion shows.

Abortion is so central to our values disputes
because respect for human life is the foundational
value of our kind of society and abortion involves
defining what that respect requires.

In Canada, having achieved a black hole on
abortion law -- there is no law -- pro-choice
advocates are not content with having the freedom to
act according to their values; they want to make
others, for whom it would be a breach of their
values, act likewise. And they want to have their
beliefs and values publicly affirmed. Obtaining
official rulings from human rights tribunals that
physicians have no freedom of conscience protection
regarding abortion establishes that their values
should predominate as the societal norms. That is
even truer when coercive legislation enshrining
those beliefs is enacted, as in Victoria.

In short, these people claim freedom of values
belief for themselves, but refuse to respect others'
freedom. That's why they will not tolerate a
respect-for-freedom-of-conscience exception. No
matter what our values or views, we should all be
concerned by such totalitarianism and
fundamentalism.